a medical librarian's adventures in evidence-based living

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The Huffington Post Interviews Dr. Caldwell Esselstyn about Heart Disease: What Causes It, How to Prevent It, and How to Reverse It With a Plant-Based Diet

But, it's much more than just subtracting foods--it's adding in a bunch of heart-saving leafy greens, multi-colored fruits and vegetables, beans, and real grains. To read how to easily increase the greens in your diet, click here.

I made the gradual switch in March of 2008. I actually thought I was a eating a healthy diet beforehand--but, I was deluding myseIf. Honestly, your food preferences DO CHANGE, the longer you eat this way. To read why I made the switch, click here.

I haven't had a follow-up lipid panel since then, because my doctor said it wasn't necessary--my numbers were already fine. My husband, however, just had his follow-up 2 weeks ago. He's off the statins, and sure enough, his numbers are better than they were on drugs.

"If the truth be known coronary artery disease is a
toothless paper tiger that need never, ever exist and if it does exist
it need never, ever progress."

So says Dr. Caldwell Esselstyn, who was a researcher and clinician
at the Cleveland Clinic for over 35 years. In 1991, Dr. Esselstyn
served as the president of the American Association of Endocrine
Surgeons, and organized the 1st National Conference on the Elimination
and Prevention of Heart Disease. In 2005, he became the 1st recipient
of the Benjamin Spock Award for Compassion in Medicine. Dr. Esselstyn
is also an Olympic gold medalist in rowing, and he was awarded the
Bronze Star as an army surgeon in Vietnam.

In this series of interviews I've conducted with extraordinary
nutritional researchers and medical doctors, I've sought to understand
the link between diet and the most common and dreaded diseases that are
prevalent in our culture. What I'm hearing over and over is that a plant based diet is both preventative and healing, whereas a diet high in animal protein is destructive to our health - this is the case with cancer, type 2 diabetes, and heart disease.

The great news is that there is very real hope in shifting the
course of our health. What is becoming very apparent through various
peer reviewed studies is that by changing our diet - eliminating that
which causes havoc in the body (animal protein) and adding in plant
based proteins and eating lots of vegetables, legumes, beans, and whole
grains, we can not only prevent disease, but also heal from it once it
is already in motion. Following is a fascinating conversation I had on
diet and heart health.

KF: What exactly is coronary heart disease?

CE: Coronary heart disease is the leading killer of women and men in
western civilization. It is predicted to become the #1 global disease
burden by 2020.

It consists of an inflammatory buildup of blockages in arteries to
the heart muscle. These blockages are made of fat, cholesterol,
calcium, and inflammatory cells. Blockages can become severe enough to
cause symptoms such as shortness of breath or chest pain (angina). When
blockages suddenly become complete, the portion of heart muscle fed by
that blocked artery is now deprived of oxygen and nutrients, thus it is
injured or now dies. This is a heart attack. The patient may survive or
succumb if the event is accompanied by a fatal heart rhythm.

KF: Who develops heart disease?

CE: Everyone eating the typical western diet. In autopsy studies of
our GI's who died in the Vietnam and Korean wars almost 80% at an
average age of 20 years, had disease that could be seen without a
microscope. Forty years later in 1999, a study of young persons between
the ages of 16-34 years who have died of accidents, homicides and
suicides, finds the disease is now ubiquitous.

KF: What is the cause of the disease?

CE: It is the typical western diet of processed oils, dairy, and
meat which destroys the lifejacket of our blood vessels known as our
endothelial cells. This cell layer is a one cell thick lining of all of
our blood vessels. Endothelial cells manufacture a magical protective
molecule of gas called nitric oxide, which protects our blood vessels.
It keeps our blood flowing smoothly, it is the strongest dilator
(widener), of our blood vessels, it inhibits the formation of blockages
(plaques), and it inhibits inflammation.

KF: With such natural protection, why do we ever develop heart disease?

CE: Every western meal of processed vegetable oils, dairy products,
and meat (including chicken and fish) injures these endothelial cells.
As individuals consume theses damaging products throughout their lives,
they have fewer functioning endothelial cells remaining and thus less
of the protective nitric oxide. Without enough nitric oxide the plaque
blockages build up and grow creating eventually heart disease and
strokes.

KF: Can it be stopped or even reversed?

CE: Yes. First we must look at the lessons learned from cultures
where there is a virtual absence of coronary artery heart disease such
as rural China, the Papua Highlands of New Guinea, Central Africa, and
the Tarahumara Indians of Northern Mexico. Their nutrition is plant
based without oil.

Beginning in 1985 I initiated a study of seriously ill coronary
artery disease patients. Their nutrition became plant based without
oil. Their cholesterol levels plummeted. Their angina disappeared.
Their weight dropped. I have reported this study at 5 years, 12 years,
and 16 years, in the peer reviewed scientific literature and again
beyond 20 years in my book Prevent and Reverse Heart Disease.
In some of the patients we had follow up angiograms (x-rays) of
previously blocked arteries demonstrating striking disease reversal,
which is a testament to my often quoted statement "The truth be known
coronary artery disease is a toothless paper tiger that need never
exist and if it does exist it need never progress." The greatest gift
to these patients is the increasing recognition that they are the locus
of control for their disease - not some pill or procedure. They have
made themselves heart attack proof and lose the greatest fear of all
heart patients and their families - when will the next heart attack
occur?

KF: What about drugs, stents, and heart bypass surgery?

CE: Admittedly in the midst of a heart attack a stent or bypass may
be live saving, however, for the remaining 90% studies confirm that
they do not prevent future heart attacks or prolong life. They are
associated with significant complications such as hemorrhage, heart
attack, stroke, cognitive decline, depression, and death. The benefits
erode with the passage of time as the stents and bypasses may
themselves develop blockage.

Some drugs may decrease blood pressure and the heart workload.
Others interfere with clotting which helps a stent remain open. Statin
drugs lower cholesterol. None of these drugs or interventions addresses
the basic causation of disease and not surprisingly the disease
progresses with the need for more drugs, stents, and repeat bypasses.

KF: Why aren't physicians using nutrition therapy?

CE: Most physicians have no training or understanding of the power
of nutrition. In a busy practice they would not have the time for it.
It is my belief that physicians must accord the plant based lifestyle
transition its due. Every patient with cardiovascular disease should be
referred to a physician or nurse practitioner with the knowledge and
expertise in these counseling skills.

KF: But I understand physicians don't believe patients will make this transition. How come?

CE: Nutrition counseling is a skill which physicians don't possess.
Of all the encounters a patient with cardiovascular disease
experiences, perhaps the least time and lowest priority is nutritional
counseling. I see many patients with heart disease who recount that
nutrition was never even mentioned. It is therefore unlikely that the
patient feels that nutrition is important.

KF: What is it that you do differently?

CE: In an intensive 5 hour counseling session for a group of heart
patients, my first priority is to eliminate the mystery of what causes
their disease. It has not been stress, or genes. It is their western
diet of processed oil, dairy, and meat. Hypertension, diabetes, and
smoking must be controlled but food trumps all. I spend at least an
hour defining the protective role of endothelial cells and nitric oxide
functioning as the ultimate guardians of our blood vessels. They
quickly understand that their lifetime of ingesting these harmful
products has totally overwhelmed and destroyed their endothelium to an
extent where it is unable to protect them. They fully grasp that they
must forever eliminate ingesting foods that will further destroy their
already compromised endothelium. They understand heart disease is a
food borne illness.

KF: Where is the good news?

CE: The patients understand that they can halt their disease. They
are presented with my scientific articles demonstrating reversal of
disease. They learn that anginal chest pain may diminish or disappear
within 10-14 days in some patients while others may take longer. We
share our data confirming reversal of carotid artery disease to the
brain, coronary artery disease of the heart, peripheral vascular
disease in the extremities, and the reversal of erectile dysfunction.
They are made to appreciate how rapidly and powerfully the endothelial
function may be restored. The most significant message in our
counseling is patient awareness that they are empowered to be the locus
of control of their disease.

KF: What is your take on the present management of heart disease through drug stents and bypass surgery?

CE: It is expensive, dangerous, and ineffective. None of these
approaches addresses the factors that cause the disease. A doctor would
never treat poison ivy without advising the patient to avoid exposure
to poison ivy plants. Sadly the usual treatment of cardiovascular
disease almost never includes hours of patient counseling so they may
completely eliminate the foods which are injuring their endothelium.
Stents may block, bypass veins shut down, drug doses increase, and
blood vessel disease worsens. The present cost of this non-treatment of
heart disease is unsustainable even in our wealthy nation.

KF: Dr. Esselstyn, are you a threat to the stenting and bypass industry?

CE: Not really. Stents and bypass surgery in an emergency setting
are absolutely lifesaving. However, for non-emergency situations an
intensive lifestyle trial of 3-6 months would eliminate the need for
most interventions. It is of interest that when physicians and some
interventional cardiologists themselves develop the disease they come
knocking at my door.

KF: Why do you think this information on diet and heart
disease is not more widely known? Is someone or something blocking your
message?

CE: The government, drug industry, and some of my own profession.
The USDA every five years produces a food triangle which promotes the
very foods which guarantee that millions of Americans will perish.

The drug industry has a $21 billion dollar income from statin drugs
alone. The stent manufacturers make billions more. Neither of these
industries would want this epidemic resolved.

Physicians who perform stents and bypass surgery earn millions and are hardly clamoring for fewer patients.

KF: Any final thoughts?

CE: When people learn to eat plant based to eliminate heart disease
it could inaugurate a seismic revolution in health. Other diseases that
resolve include obesity, hypertension, stroke, heart attacks, gall
stones, diverticulitis, asthma, osteoporosis, allergies, rheumatoid
arthritis, multiple sclerosis, lupus, and a marked decrease in the
common western cancers of breast, prostate, colon, endometrial,
ovarian, and pancreatic.